Hearing the service-user voice: evidence for the advantages of taking the service-user perspective into the design of service delivery
Background: Current harm reduction interventions have had limited success in stemming the high incidence of hepatitis C virus (HCV) infection among people who inject drugs (PWID). Service users are evidenced as interested in HCV treatment, yet uptake is low. We present findings from two research projects to illustrate the advantages of taking the service user perspective into the design of service delivery.
Methods: Data collection for the HCV prevention ‘Staying Safe’ study comprised multiple in-depth interviews with 37 long-term London-based injectors in 2010 and 2011. Data collection for the HCV treatment ‘Barriers and Facilitators’ study comprised in-depth interviews with 35 HCV positive service users and 12 service providers at two London drug and alcohol services.
Findings: ‘Staying Safe’: The majority of participants had a present focused temporal orientation and did not view HCV as a pressing concern. The facilitation of venous access and care was an initial and enduring rationale for safe injecting practices. Participants expressed an unmet desire for non-judgemental venous access information and advice. ‘Barriers and facilitators’: Service users described a number of social / structural barriers to HCV treatment uptake. Services that attended to these needs were more effective in encouraging treatment uptake. Methadone ‘takeaway’ provision was of central importance to participants in both studies, with implications for engagement in both HCV prevention and treatment.
Conclusion: Service delivery interventions that attend to the short term pragmatic concerns of service users have the potential to reengage PWID who are disenchanted with harm reduction and HCV treatment messages.
Funding sources: The Staying Safe project was funded by a grant from the Economic and Social Research Council. The HCV Treatment Barriers and Facilitators project received funding from the World Health Organization Regional Office for Europe, the European Commission Directorate of Health and Consumers, and the National Institute for Health Research.